Early Initiation of Diabetes Devices Relates to Improved Glycemic Control in Children with Recent-Onset Type 1 Diabetes Mellitus

Abstract

Objective: To test whether the addition of an insulin pump or continuous glucose monitor (CGM) related to reduced glycated hemoglobin A1c (HbA1c) in large cohort of children, 5-9 years old, and within 1 year of their type 1 diabetes (T1D) diagnosis. Research Design and Methods: The study uses data from families of children with recent-onset T1D and who were between 5 and 9 years old. Study analyses used children's HbA1c values at baseline and at the 6-month follow-up. Parents reported on family demographics and children's T1D device use in their daily management (e.g., insulin pump or CGM). Children's mean T1D duration was 4.70 ± 3.28 months at baseline, so the 6-month assessment point was ∼12 months postdiagnosis. Results: One hundred-eleven families participated. At baseline, child mean age was 7.51 ± 1.37 years, and mean child HbA1c was 7.65% ± 1.40%. In addition, 17% of children used an insulin pump, and 17.1% of children used CGM. Six months later, 35.1% of children had started an insulin pump and 25.2% had started CGM. Repeated measures analyses of variance results showed a smaller overall HbA1c between baseline and 6 months for children using an insulin pump versus children not on a pump. For CGM, results showed that children starting a CGM during this window had a significantly lower HbA1c level than children who had not started on CGM. Conclusions: The study results suggest that early initiation of either an insulin pump or CGM in children newly diagnosed with T1D may help to improve child HbA1c levels within the first 12 months of diabetes.

Keywords: Continuous glucose monitoring; Continuous subcutaneous insulin infusion; HbA1c; New onset; Pediatrics; Type 1 diabetes.

FIG. 1.

(A) The change in HbA1c from baseline to 6-month follow-up for children starting a pump between baseline and 6-month follow-up and children not starting a pump between baseline and 6-month follow-up. (B) The change in HbA1c from baseline to 6-month follow-up for children starting a CGM between baseline and 6-month follow-up and children not starting a CGM between baseline and 6-month follow-up. Error bars represent the standard error. CGM, continuous glucose monitor; HbA1c, hemoglobin A1c. Supplemental materials present pump and CGM data that include error bars that represent 95% confidence intervals (Supplementary Fig. S1) and error bars that represent ±1 standard deviation (Supplementary Fig. S2).